BCHHS Public Health Provider COVID Update

December 30, 2021

COVID-19 Update

Data

  • As of today, there have been 32,796 confirmed cases of COVID-19 and 452 COVID-19-related deaths in Buncombe County residents since the start of the pandemic.
  • As expected with spread of the omicron variant and holiday gatherings, a rapid increase in cases has been seen locally, in NC and across the US. The case rate in Buncombe County has jumped to 360 cases per 100,000 population in the last 7 days. The 14-day percent positivity has increased to 8.8% in Buncombe and is 22% statewide. Testing demand is very high. We expect to see a continued increase in cases in the coming weeks, following holiday and NYE gatherings and further spread of the omicron variant.
  • Not surprisingly, Buncombe County is still considered to have a high level of community transmission, per the CDC.
  • COVID-related hospitalizations in WNC continue to trend up. (There were 90 inpatients with COVID-19 in the Mission system this morning, including 60 at Mission Hospital.) ICU utilization in our region is fairly stable.
  • Per the NCDHHS dashboard, 68% of the total Buncombe County population is partially vaccinated and 64% is fully vaccinated. When considering only those eligible for vaccination (5 years of age and older), 71% of this population in Buncombe County is partially vaccinated and 68% is fully vaccinated.
  • The NCDHHS weekly Respiratory Disease Surveillance Report contains a wide variety of data on COVID-19, influenza and other respiratory infections and was updated today.

Omicron variant

  • The Omicron variant was first identified in North Carolina the week ending December 11th. With the lag in sequencing results, we don’t know the current proportions of variants in the state, and no local data is available to us. Per CDC’s Nowcast modeling, omicron is estimated to be the dominant variant in the southeastern US at this time. The NCDHHS weekly Respiratory Disease Surveillance Report that was published today states that for the week ending 12/18/21, omicron represented 14% of sequenced variants in NC.
  • The CDC, NCDHHS and BCHHS urge people to get vaccinated with an mRNA vaccine (Pfizer or Moderna) as soon as possible and to get a booster as soon as they are eligible to help prevent serious illness, hospitalization and death.
  • Data from South Africa and the United Kingdom demonstrate that vaccine effectiveness against infection for two doses of an mRNA vaccine is approximately 35%. A COVID-19 vaccine booster dose restores vaccine effectiveness against infection to 75%. COVID-19 vaccination continues to decrease the risk of severe disease, hospitalization, and death from COVID-19.

Vaccine updates

  • Earlier this month, the CDC strengthened its booster recommendations and now encourages everyone 16 years of age and older to receive a booster shot.
    • At this time, only the Pfizer-BioNTech COVID-19 vaccine is authorized to be given as a booster dose to those 16 and 17 years of age at least six months after completion of a primary vaccination series with the Pfizer-BioNTech COVID-19 Vaccine. 
    • Please note: Written parental consent is required for 16- and 17-year-olds to receive the booster.
  • On 12/14/21, the FDA added a contraindication to the J&J COVID-19 vaccine stating that it should not be administered to individuals with a history of thrombosis with thrombocytopenia following receipt of the J&J COVID-19 vaccine or any adenovirus vector COVID-19 vaccine (e.g., the AstraZeneca COVID-19 vaccine). See the updated J&J COVID-19 vaccine EUA fact sheet for healthcare providers here.
  • Additionally, on 12/16/21, the CDC recommended that mRNA vaccines (Moderna or Pfizer) be preferentially administered, when possible and appropriate, due to superior safety and effectiveness data when compared to the J&J vaccine.
    • The CDC emphasized that receiving any COVID-19 vaccine is better than remaining unvaccinated, and J&J vaccine can still be administered to those who cannot or choose not to get an mRNA vaccine, as long as they do not have a contraindication.
  • The CDC has updated their Interim Clinical Considerations for Use of COVID-19 Vaccines to reflect these changes to guidance. Additional updates to this document include:
    • Reports of falsely reactive Rapid Plasma Reagin (RPR; non-treponemal) test results occurring with certain RPR tests for at least five months following COVID-19 vaccination in some people. Treponemal testing for syphilis such as Treponema pallidum particle agglutination (TP-PA) and treponemal immunoassays do not appear to be impacted by this issue.
    • Updated information about a second formulation of Pfizer-BioNTech COVID-19 Vaccine that is authorized for use in persons age 12 years and older and does not require dilution prior to use. This formulation uses tromethamine (Tris) buffer, like the pediatric (10 mcg) formulation.
    • Updated information on vaccinating people during quarantine after a known SARS-CoV-2 exposure or during COVID-19 outbreaks

Changes to isolation and quarantine guidance for healthcare personnel and the general public

  • Last week, the CDC updated its guidance on managing Healthcare Personnel with SARS-CoV-2 infection or exposure due to the increased transmissibility of the omicron variant and concerns about potential impacts on the healthcare system.
  • Earlier this week, the CDC updated its guidance on isolation and quarantine for the general public.
    • The recommended time for isolation has been decreased from 10 days to 5 days for people with COVID-19, if asymptomatic, followed by 5 days of wearing a mask when around others.
      • The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.
    • Quarantine guidance differs based on the exposed person’s vaccination status, including whether they have received a booster dose or how far out they are from completion of their primary vaccine series.
      • Unvaccinated individuals with prior COVID infection are considered unvaccinated and unprotected for the purposes of quarantine. This is because data has shown that past infection does not offer much protection against the Omicron variant.
  • NCDHHS and BCHHS have adopted this new guidance. The state issued a press release yesterday conveying this.
  • Today, NCDHHS updated the StrongSchoolsNC Toolkit isolation and quarantine guidance to align with the updated CDC guidance. I encourage you to review pages 15-16 of the updated toolkit as we prepare for students to return to school on Monday.
  • We are waiting to see if updates regarding isolation and quarantine are issued for other special populations, including childcare facilities, colleges and universities, LTCFs, correctional facilities and jails, homeless shelters and other congregate living settings. Until that guidance is updated, we will continue to follow past guidance.
  • As you can see from these updated guidance documents, receipt of all vaccine for which an individual is eligible, including a booster dose if indicated, is a key determinant of whether work, school or other activity restrictions are to be implemented. The CDC has functionally changed the definition of fully vaccinated to include a booster, although they have not yet officially changed the definition.

Monoclonal antibodies (mAbs)

  • The FDA recently updated the Healthcare Provider Fact Sheets for bamlanivimab and etesevimab (bam/ete) administered together, REGEN-COV, and sotrovimab with specific information regarding expected activity against the Omicron variant.
    • These data show that it is unlikely that bam/ete or REGEN-COV will retain activity against this variant. Sotrovimab appears to retain activity against the Omicron variant, but is in extremely short supply. (To give some context to supply issues, this week only 756 patient courses of sotrovimab were made available to be allocated throughout the entire state of NC.) Local providers are working on obtaining sotrovimab and some may receive it this week.
    • Given the extremely limited availability of sotrovimab, providers have been encouraged to review and follow the NIH treatment guidelines on prioritization of COVID-19 therapies and limit use to treatment only of unvaccinated or immunocompromised people at high risk for severe disease, hospitalization or death.
  • NCDHHS has a website to assist with finding a provider offering mAbs for COVID-19.
  • Click here for a side-by-side overview of mAb treatments currently allocated by the federal government.

Oral antivirals

  • On 12/22/21, the FDA issued an EUA for the first oral antiviral for the treatment of mild-to-moderate COVID-19 in those 12 years of age and older weighing at least 40 kg who are at high risk for progression to severe COVID-19, including hospitalization or death.
    • Pfizer’s Paxlovid will be available by prescription only and the 5-day treatment course should be initiated ASAP after diagnosis of COVID-19 and within 5 days of symptom onset.
    • Additional information from NCDHHS on Paxlovid can be found here.
  • On 12/23/21, Merck’s molnupiravir received EUA for the treatment of the treatment of mild-to-moderate COVID-19 in those 18 years of age and older who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.
    • It is available by prescription only and the 5-day treatment course should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset.
    • The FDA issued important safety information to healthcare providers regarding the use of this drug in pregnancy and in individuals of childbearing potential due to the potential for fetal harm, based on animal studies.
    • Additional information from NCDHHS on molnupiravir can be found here.
  • Very limited allocations of these antivirals were to arrive in NC this week. I am working on figuring out how providers can access these treatments for their patients from local pharmacies and hope to have more info for you next week.
  • FDA documents regarding COVID-19 therapeutics can be found here.

Updates on Buncombe County COVID-19 Vaccination Efforts

  • Walk-in COVID-19 Vaccine Clinic
    • BCHHS building, 40 Coxe Avenue in downtown Asheville
    • All FDA-authorized or FDA-approved COVID-19 vaccines and all doses are available here.
    • The Buncombe County COVID Vaccine Clinic, like other non-emergency county services, will be closed Friday, 12/31.
    • Starting the week of 1/3/2022, the clinic will be open Monday-Friday from 9am-4pm.
    • No appointment is needed.
  • COVID-19 vaccines for the homebound
    • We continue to work with the Mission Health Partner CaraMedics to administer COVID-19 vaccine to those living in Buncombe County who cannot easily leave their homes to access vaccination.
    • If you know someone in need of this service, have them or their caregiver call the Buncombe County Ready Team at 828-419-0095.

Influenza Update

If you have any concerns or questions about COVID-19 or any other communicable disease, please contact the Buncombe County Communicable Disease staff at 828-250-5109 (available 24/7/365).

Wishing you a peaceful, healthy and joyous New Year, and one free from COVID surges,

Jenni

 

Jennifer Mullendore, MD, MSPH

She/Her

Health & Human Services – Medical Director

(828) 250-6308 cell (828) 989-6145

40 Coxe Ave., Asheville, NC 28801 

Respect. Integrity. Collaboration. Honesty. Equity.

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